The long-discussed expansion of Medicaid eligibility in North Carolina is perhaps simultaneously closer to occurring and more contentious than ever.
It’s an opportunity for good leadership to shine by working to help the public’s best interest prevail over partisanship before the situation deteriorates further.
Setting the stage is Democratic Gov. Roy Cooper’s insistence on including Medicaid expansion in the new biennial budget and the failure of Republican lawmakers, who control the House and Senate, to include this in the spending plan released and endorsed by both legislative branches this week.
The GOP-authored budget proposal has a provision encouraging Cooper to call a special legislative session to consider health care access legislation such as Medicaid expansion, but it doesn’t require anything.
Cooper and GOP leaders in the legislature are blaming each other for the failure to compromise, with the governor saying Republican legislators didn’t seriously consider his Medicaid expansion and other proposals and the other side saying Cooper never put forth specific counter-offers.
With enough Democrats in the legislature to uphold his veto, Cooper is now poised to block the budget plan supported by the House and Senate. This could delay approval of a new budget for months. During this time, pay raises for teachers and state government employees would be on hold and progress on other fronts would be delayed since state government would operate under 2018-19 budget spending levels.
Instead of subjecting North Carolina to government ruled by partisan politics, the state’s leaders should build on efforts for compromise this legislative session such as House Bill 655. Although introduced by 24 Republicans and one Democrat and supported by other Democrats, it was left to die in a committee.
Like Cooper’s proposal, House Bill 655 would increase the Medicaid eligibility threshold to 138% of the federal poverty level instead of the current 142%.
House Bill 655 differs from Cooper’s proposal by requiring that newly eligible adults pay monthly premiums and comply with work requirements unless they are exempt due to certain conditions.
Altnough these requirements could decrease participation and would make a federal waiver necessary, House Bill 655 was a significant step in the right direction. The bill demonstrated bi-partisan support for expansion of Medicaid eligibility and that compromise is possible on this issue.
The federal government would fund 90% of the cost of expanding Medicaid eligibility in North Carolina. Plans have been put forth for generating the state’s 10% match, including having it come from hospitals and providers.
Through their federal taxes, North Carolinians are already paying more than $1 billion a year for Medicaid expansion in other states. Expanding eligibility would bring those tax dollars home.
Expanding eligibility would result in about 365,000 uninsured North Carolinians being able to get Medicaid coverage and create over 37,000 new jobs statewide, according to a non-partisan analysis prepared by researchers at George Washington University with funding from Cone Health Foundation and the Kate B. Reynolds Charitable Trust.
Of particular importance is the impact of expanding Medicaid eligibility on people who now make too much money to qualify for Medicaid, but not enough to qualify for a federal subsidy to purchase health insurance in a separate program. The expansion would make these people eligible for Medicaid.